Term
| shortness of breath while lying flat |
|
Definition
| orthopnea (dyspnea while laying flat) |
|
|
Term
| which valvular disease presents the highest risk for surgery |
|
Definition
|
|
Term
| why is antibiotic prophylaxis no longer recommended by the AHA to prevent endocarditis |
|
Definition
-risks don't outweight benefits
-no clear evidence it helps |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| patients with a recent upper respiratory infection should wait how long before surgery? |
|
Definition
|
|
Term
| smokers should abstain for ____ before surgery to: _____ |
|
Definition
4-8 weeks
improve ciliary function
decrease sputum production |
|
|
Term
|
Definition
| cerebral vascular accident (stroke) |
|
|
Term
|
Definition
transient ischemic attack (mini-stroke)
change in blood flow to part(s) of brain
can be irreversible if prolonged |
|
|
Term
| what 2 neurological diseases are strong predictors of cardiac mortality |
|
Definition
TIA (transient ischemic attack)
CVA (cerebral vascular accident, stroke) |
|
|
Term
| a patient with severe systemic disease limiting activity but not incapacitating...which ASA class |
|
Definition
|
|
Term
| a patient with incapacitating disease that is a constant threat to life...which ASA class |
|
Definition
|
|
Term
| Patient with mild systemic disease...which ASA class |
|
Definition
|
|
Term
|
Definition
|
|
Term
| MIO (related to airway assessment) |
|
Definition
|
|
Term
| which mallampati class(es) pose a higher risk of an obstructed airway during sedation? |
|
Definition
|
|
Term
| which mallampati class shows the soft palate, portion of uvula and tonsillar pillars |
|
Definition
| Class II (Class I shows all of uvula and ant/post tonsillar pillars) |
|
|
Term
| which mallampati class shows the hard palate only |
|
Definition
|
|
Term
| what are some predictors of difficult intubation? |
|
Definition
maximal incisal opening less than 4cm adult
thyro-mental distance less than 6.5
obesity (BMI >30)
retrognathic, class II occlusion |
|
|
Term
| what is the minimum fasting times for clear liquids and light meals |
|
Definition
2 hours clear liquid
6 hours light meal |
|
|
Term
| preoperative medication considerations... |
|
Definition
no diuretics
stress-doze steroids
no PO anticoagluants
adjust insulin
transfusions and antibiotics if needed |
|
|
Term
| most common problem in anesthesia surgery |
|
Definition
| failure to ventilate patient |
|
|
Term
| 5 points in the conscious continuum |
|
Definition
awake (baseline)
drowsy
conscious sedation
deep sedation
general anesthesia |
|
|
Term
| at what level of consciousness do oral surgeons attempt to achieve |
|
Definition
| inbetween drowsy and conscious sedation |
|
|
Term
| level of sedation equivalent to anxiolysis |
|
Definition
|
|
Term
| level of sedation where patient cannot be aroused, may not be able to maintain airway, cardiovascular fx maintained |
|
Definition
|
|
Term
| level of sedation where patient unable to maintain basic autonomic function |
|
Definition
|
|
Term
| when assessing a patient's level of responsiveness, what are the three assesment in order |
|
Definition
response to...
voice
touch
pain |
|
|
Term
| limitations of oral delivery... |
|
Definition
delayed time of onset
difficulty in giving antidote/reversal |
|
|
Term
| disadvantages of inhalation anesthetics |
|
Definition
not as potent
cost, space requirements |
|
|
Term
|
Definition
| nothing to eat or drink the night before the procedure |
|
|
Term
|
Definition
OXYGENATION
TEMPERATURE
CIRCULATION
VENTILATION |
|
|
Term
| basic anesthetic monitoring standard 1 |
|
Definition
| someone qualified in room at all times |
|
|
Term
| basic anesthetic monitoring standard 2 |
|
Definition
continuous monitoring of...
oxygenation, ventilation, circulation, and temperature |
|
|
Term
| what does a pulse oximeter measure |
|
Definition
| percentage of oxygenated hemoglobin |
|
|
Term
|
Definition
| a weighted stethoscope attached to chest or neck |
|
|
Term
|
Definition
| measures end-tidal CO2 (concentration of CO2) |
|
|
Term
| what is the difference between P co2 and ET co2 |
|
Definition
partial pressure of CO2 in arteries vs. excreted
typically less than 5mm difference in measurement |
|
|
Term
| a capnograph can be an early warning for |
|
Definition
malignant hyperthermia
(also apnea, and basically any alteration in ventilation) |
|
|
Term
| how often is blood pressure monitored |
|
Definition
| every 5 minutes, using a cuff |
|
|
Term
| EKG characteristic of atrial fib. |
|
Definition
no real distinct P-wave
multiple atrial spikes |
|
|
Term
| EKG characteristic of ventricular tachycardia |
|
Definition
| 3 or more premature ventricular contraction spikes in a row ( 3 PVC'S) |
|
|
Term
| Many ventricular ectopic foci resulting in an erratic rapid twitching of the ventricles |
|
Definition
ventricular fibrillation
-erratic beat, can't see PQRS wave |
|
|
Term
| cardiac emergencies requiring AED |
|
Definition
| ventricular tachycardia and fibrillation |
|
|
Term
| 3 major classes of ASH drugs |
|
Definition
benzos
barbs
antihistamines |
|
|
Term
|
Definition
|
|
Term
| benzodiazepine metabolites are conjugated primarily with what? |
|
Definition
|
|
Term
| what short of patients should avoid benzodiazepines |
|
Definition
| those with LIVER or KIDNEY disease |
|
|
Term
| an adverse effect of injecting diazepam |
|
Definition
thrombophlebitis
(inflammation of a vein from a blood clot) |
|
|
Term
| a marketed active metabolite of diazepam |
|
Definition
|
|
Term
| administration protocol for flumazenil |
|
Definition
|
|
Term
| barbituate with highest anticonvulsant action |
|
Definition
|
|
Term
| T/F opioids possess active metabolites |
|
Definition
|
|
Term
|
Definition
|
|
Term
| T/F opiod receptors are found in peripheral tissues |
|
Definition
|
|
Term
| analgesic effects of opioids (3) |
|
Definition
Increase pain threshold and tolerance
Inhib subs.P release from dorsal root ganglia
Inhib C and A delta fiber stimulation |
|
|
Term
| opioids should be given with caution in what type of patients |
|
Definition
COPD
-respiratory depression risk |
|
|
Term
| some opioid withdrawal effects |
|
Definition
| lacrimation, yawning, myalgia, hyperventilation, hyperthermia, mydriasis, vomiting, diarrhea, anxiety, hostility |
|
|
Term
| opioids cause miosis or mydriasis? |
|
Definition
MIOSIS
(mydriasis can occur in a withdrawal rxn) |
|
|
Term
| which drug(s) is contrainidicated for those on MAOI's |
|
Definition
| meperidine (Demerol) and fentanyl |
|
|
Term
| 3 opioid agonist-antagonists |
|
Definition
Pentazocine (Talwin)
Nalbuphine (Nubain)
Butorphanol (Stadol) |
|
|
Term
| T/F Propofol does not have analgesic effects |
|
Definition
| T, it lacks analgesic properties |
|
|
Term
| propofol causes nausea and amnesia |
|
Definition
| causes AMNESIA, NOT nausea |
|
|
Term
| a positive and 2 negative effects of ketamine |
|
Definition
+ protective reflexes intact
- stimulates CV, increase airway secretions
(nausea, vomiting) |
|
|
Term
| loss of consciousness often leads to...(2) |
|
Definition
loss of muscle tone
airway obstruction |
|
|
Term
|
Definition
AIRWAY
BREATHING
CIRCULATION |
|
|
Term
systolic pressure minimums associated with
carotid
femoral
radial |
|
Definition
60mm carotid
70mm femoral
80mm radial |
|
|
Term
| pulse point used for infants... |
|
Definition
|
|
Term
| postural hypotension will often occur when BP changes by ... |
|
Definition
|
|
Term
| disease which increases risk of postural hypotension |
|
Definition
addison's disease
(adrenal produces insufficient steroids)
-treated with cortisol |
|
|
Term
|
Definition
| degenerative neurological failure, with primarily the autonomic side failing |
|
|
Term
| regulates the metabolism of pteins, fats, water, electrolytes |
|
Definition
|
|
Term
secreted by adrenal medulla ____
secreted by adrenal cortex _____ |
|
Definition
Medulla- EPI AND NE
Cortex- gluco, minero, sex hormones |
|
|
Term
|
Definition
circulating cortisol
sleep patterns, schedules
stress (via hypothalamus) |
|
|
Term
| adrenal insufficiency can lead to... |
|
Definition
lethargy, weakness, nausea
hypERkalemia
hyPOglycemia
hyPOtension |
|
|
Term
what's a normal amount of cortisol per day
..a stressful amount of cortisol per day |
|
Definition
|
|
Term
| highly potent corticosteroid |
|
Definition
dexamethasone
(0.75mg equivalent to 25mg of cortisol) |
|
|
Term
|
Definition
in regards to adenocortical suppression when receiving glucocorticoid therapy:
-20 mg or more daily
-continuous use for 2 weeks or longer
-within 2 years |
|
|
Term
| medication adjustment for a patient on glucocorticoids coming to see you |
|
Definition
| up dose 2-4x on day of visit |
|
|
Term
| acute adrenal insufficiency managment includes... |
|
Definition
ABCD
(Deliver 100mg hydrocortisone over 30 min)
assume supine position
maybe glucose and fluids |
|
|
Term
hyPERthyroid thyrotoxicosis
nonhyperthyroide thyrotoxicosis |
|
Definition
associated with Grave's disease
associated with facticious thyrotoxicosis |
|
|
Term
| thyrotoxic crisis or thyroid storm symptoms |
|
Definition
fever
tachy
hypotension
delirium
heart failure |
|
|
Term
|
Definition
ABC D
(deliver decadron, B-blocker, iodide, methimazole) |
|
|
Term
| seizure etiology are mainly primary or secondary? |
|
Definition
65% primary
secondary include congenital, trauma, tumor, disease, metabolic disorders... |
|
|
Term
generalized seizures include...
partial seizures include... |
|
Definition
grand-mal and petit-mal
simple and complex |
|
|
Term
| treatment for hypoglycemia |
|
Definition
dextrose IV
glucagon subcut.
glucose transmucosal |
|
|
Term
| ASA classifications to avoid GA |
|
Definition
| type IV and some type III |
|
|
Term
|
Definition
REM stage
unhibited, sometimes dangerous response to stimuli
vomiting, uncontrolled mvmt. |
|
|
Term
|
Definition
surgical anesthesia
eye mvmt stops
skeletal mm. relax
regular breathing |
|
|
Term
| patient's loss of consciousness indicative of what state of GA |
|
Definition
|
|
Term
|
Definition
aid in visualization of trachea during intubation
held in LEFT hand |
|
|
Term
which airway is more tolerated
naso or oro-pharyngeal |
|
Definition
| nasopharyngeal more tolerated |
|
|
Term
| fastest GA gas, less potent |
|
Definition
|
|
Term
sweet smelling, 2nd fastest GA gas,
avoid with renal patients |
|
Definition
|
|
Term
| measurement of anesthetic gas potency |
|
Definition
MAC
-dose at which gas produces effect |
|
|
Term
| factors which can decrease MAC |
|
Definition
age
hypothermia
pregnancy
HTN drugs
CNS deps |
|
|
Term
| factors which increase MAC |
|
Definition
MAOI
hyperthermia
alcohol abuse |
|
|
Term
| some causes of pain upon injection (4) |
|
Definition
-rapid injection
-dull needle (from multiple injections)
-barbed needles (from contact with bone)
-periosteal trauma |
|
|
Term
| causes of burning upon injection |
|
Definition
rapid injection
carpule contamination
pH of solution |
|
|
Term
| causes of persistent amnesthesia, or paresthesia |
|
Definition
trauma to nerve or nerve sheath
contaminated carpule
injection near foramen causes hematoma/edema |
|
|
Term
| hypersthesia vs dysthesia |
|
Definition
hyper- INCREASED rxn to noxious stimuli
dys- reaction to NON-noxious stimuli |
|
|
Term
|
Definition
large vol. of anesthetic
inflammation of masticatory mm.
infection post-injection
hematoma
trauma |
|
|
Term
|
Definition
NSAIDS
mm. relaxant
WARM compress |
|
|
Term
|
Definition
COLD (ice 24hr)
Pressure
Time... |
|
|
Term
etiology of hematoma..
where they occur.. |
|
Definition
tear of artery/vein following needle-stick
occur in fascial spaces |
|
|
Term
| how do infections travel (post injection caused) |
|
Definition
|
|
Term
| 4 local complications of local anesthetics |
|
Definition
tissue necrosis, sloughing
infection
facial nerve VII paralysis
soft-tissue injury (lip/tongue biting) |
|
|
Term
| ways to avoid self-inflicted tissue injury (lip/tongue biting) |
|
Definition
short-acting anesthetics (mepivicaine)
vaseline/lubricate lips
rises (?) |
|
|
Term
| location of facial nerve trunk |
|
Definition
inferior to lowest bony aspect of ext aud meatus
by ~1.5-2.8cm |
|
|
Term
| Facial nerve crosses the zyomatic arch from the ____ margin of the bony external canal |
|
Definition
|
|
Term
| eye related complications from locals |
|
Definition
conjunctiva dilation (red eye)
ptsosis (drooping eyelid)
diploplia
loss of corneal reflex (blinking) |
|
|
Term
| orap-related local anesthetic complication |
|
Definition
herpetic ulceration- reactivation of das herpes
apthous ulceration- canker sore |
|
|
Term
| Airways become ___ as you move toward the periphery but the total cross-sectional area ___ |
|
Definition
DIAMETER- smaller
AREA- increases |
|
|
Term
central chemoreceptors respond to _____
peripheral chemoreceptors respond to ____ |
|
Definition
central- CO2
peripheral- O2 |
|
|
Term
| on a radiograph, the disappearance of vascular markings occurs upon... |
|
Definition
|
|
Term
| pulm disease that produces frequence infections, but mild dyspnea and copious sputum |
|
Definition
|
|
Term
| pulm. disease which has few infections but severe dyspnea |
|
Definition
|
|
Term
| frequently overweight individuals are associate with (chronic bronchitis or emphysema) |
|
Definition
|
|
Term
| mucous production sufficient to cause cough with expectoration for at least __ months of the year for ___ consecutive years defines ____ |
|
Definition
3 months of year for 2 years
chronic bronchitis |
|
|
Term
| disease associated wih degraded alveoli walls, resulting in less gas exchange (SA:Vol is too low) |
|
Definition
|
|
Term
| pulmonary function tests include... |
|
Definition
spirometry
peak flow measurement
ABG |
|
|
Term
| amount of air which moves in or out of lungs during breathing |
|
Definition
|
|
Term
| maximum a person can exhale after a full inspiration |
|
Definition
|
|
Term
|
Definition
| maximum someone can exhale in 1 second, after full inspiration |
|
|
Term
| most accurate method for measuring lung capacities |
|
Definition
|
|
Term
| what does spirometry measure |
|
Definition
inspiratory flow rate
expiratory flow rate
vital capacity |
|
|
Term
| what is the FEV1 for a patient with COPD |
|
Definition
|
|
Term
| FEV1 / VC for a COPD patient |
|
Definition
|
|
Term
|
Definition
|
|
Term
| what are normal values for a peak flow meter |
|
Definition
|
|
Term
| pulmonary function test method that patients can use at home |
|
Definition
|
|
Term
with a COPD patient, what happens to:
Pa O2
Pa CO2
pH |
|
Definition
O2 goes down, CO2 up
pH low (respiratory acidosis) |
|
|
Term
| values for P O2 and P CO2 for COPD |
|
Definition
|
|
Term
| dental considerations for COPD patients |
|
Definition
upright chair
DONT USE N20
NO bilateral blocks
increase steroids
ONLY some benzos OK
NO GA |
|
|
Term
| hyperirrability of the tracheobronchial tree leading to bronchospasms |
|
Definition
|
|
Term
| extrinsic asthma is (early/adult) onset and (increases/decreases) with age |
|
Definition
extrinsic, early onset, decreases with age
(can grow out of it) |
|
|
Term
| there is reduced pharmacological activity with which type of asthma |
|
Definition
|
|
Term
| Which type of asthma is associated with family history |
|
Definition
EXTRINSIC
(also an increase in IgE levels) |
|
|
Term
| treatment of asthmatic attack |
|
Definition
change position
02
inhalers- meds
epinephrine
cortisol
intubation and ventilation |
|
|
Term
| pharm treatment of asthma |
|
Definition
bronchodilators
corticosteroids
mast cell stabilizers
anticholinergics |
|
|
Term
| drugs to avoid for asthmatic patients |
|
Definition
aspirin and NSAIDS
(they should use aceto) |
|
|
